Independent Provider

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

License

242003723 Issued in IL

Legal business name

INDEPENDENT PROVIDER

Practice address

3800 W 106TH St
Chicago, IL 60655-3815

Phone

(773) 759-2403

NPI assigned

May 15, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kathleen Moloney, M.S. CF-SLP

Title

Speech-Language Pathologist

Phone

(773) 759-2403

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1463270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463270400000",
    "number": "1558718023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3800 W 106TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606553815",
            "telephone_number": "773-759-2403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3800 W 106TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606553815",
            "telephone_number": "773-759-2403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENT PROVIDER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-15",
        "last_updated": "2016-05-15",
        "status": "A",
        "authorized_official_last_name": "MOLONEY",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_title_or_position": "SPEECH-LANGUAGE PATHOLOGIST",
        "authorized_official_telephone_number": "773-759-2403",
        "authorized_official_credential": "M.S. CF-SLP"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "IL",
            "license": "242003723",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Early Intervention Provider Agency in Chicago, IL
• Providers in Chicago, IL by specialty
• Early Intervention Provider Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.